Infective Vaginal Discharge among Women of the Reproductive Age in the Outpatient Department of a Primary Care Centre

Introduction

Infective vaginal discharge is the most common complaint of the women of reproductive age group attending gynaecology outpatient department. Vaginal discharge may be normal or abnormal. Infective vaginal discharge is usually related to one of the three conditions, like bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. This study aimed to find out the prevalence of infective vaginal discharge among women of the reproductive age in the outpatient department of a primary care centre.

Methods

A descriptive cross-sectional study was carried out among women of the reproductive age group visiting the outpatient Department of the primary care hospital from 1 March 2022 to 1 August 2022 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 138 patients, infective vaginal discharge was found in 42 (30.43%) (21.32-39.54, 95% Confidence Interval). Bacterial vaginosis was seen in 22 (52.38%), Candida was seen in 13 (30.95%), and Trichomonas was seen in 7 (16.66%) cases.

Conclusions

The prevalence of infective vaginal discharge was lower as compared to other studies done in similar settings.

Keywords

bacterial; candidiasis; prevalence; vaginitis.

Perception Regarding Early Clinical Exposure among Second Year Medical Students after Educating Pregnant Women on Physiological Changes during Pregnancy: A Mixed Methods Study

Introduction: The traditional teaching-learning process should reform to improve the academic performance and understanding of the students. This study aimed to determine the perceptions of second-year medical students towards early clinical exposure about their approach to educating pregnant women on the physiology of pregnancy. Methods: This was a descriptive cross-sectional study with a mixed-method design comprising both quantitative and qualitative components among second-year medical students of a medical college in Nepal from September 2019 to September 2020. After ethical approval from the Institutional Review Committee (Reference number: 207), 40 students included through the convenience sampling method. These students were subjected to early clinical exposure in the form of educating pregnant women on physiological changes during pregnancy. Data was entered and analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 34 responses, majority of the students 29 (85.28%) (73.36-97.20 at 95% Confidence Interval) were motivated to learn the physiology of pregnancy after the activity; 15 (44.11%) strongly agreed and 14 (41.17%) agreed to this statement. Thirty-two students (94.11%) claimed that the activity improved their understanding of the physiology of pregnancy. The majority of the students expressed that this approach is pragmatic which ignited more curiosity regarding the subject matter. Conclusions: The majority of the students had satisfactory perceptions regarding their early clinical exposure which was similar to standard data and they expressed that they would like to have similar activities in the future.

Prevalence of Anxiety in Pregnancy during COVID 19 pandemic in Shree Birendra Hospital, Chhauni

Aim: To determine the prevalence of anxiety in pregnancy during COVID19 pandemic in Shree Birendra Hospital, Chhauni Method: It is a cross sectional study conducted at Shree Birendra Hospital Chhauni from July to October 2020 following the ethical approval from IRC. All the pregnant women from first to last trimester attending outdoor visit were included; they were asked to fill up Beck Anxiety Index form. The level of anxiety was compared with demographic data like age, race, parity, and period of gestation, education and occupation. Data were analyzed by using SPSS 20 software. Results: A total of 385 presumably uninfected pregnant women were surveyed in 20-40 (28.45±3.95) years age group from 4 to 41 (27.15±9.4) weeks of pregnancy and 55.6% were multipara. Low-grade anxiety was found 99.5% (BAI= 3.06±3.66). Conclusions: Low-grade anxiety was found in almost all pregnant women during covid pandemic and there was no significant difference by demographic variables.

Correlation of Cardiotocography with Intraoperative findings and neonatal outcome in caesarean section for non-reassuring fetal status

Aims: To demonstrate the correlation of cardiotocography with intraoperative findings and neonatal outcome undergoing emergency cesarean section for non-reassuring fetal status. Methods: It is a hospital based cross sectional study at maternity ward of Shree Birendra Hospital in Kathmandu with non-reassuring CTG who underwent cesarean section in a period of one year. Their CTG were correlated with their intraoperative findings and neonatal outcome such as meconium stained liquor, nuchal cord, Apgar score at birth, NICU admission, perinatal mortality and stillbirth. Results: Fifty four patients were recruited. Most common operative finding was meconium stained liquor (35.2%); and cardiotocographic abnormality was variable Deceleration (37%). Variable deceleration and late deceleration had significant correlation with meconium stain liquor and nuchal cord. Apgar score ≤ 7 at 5 minute was 7.4%. NICU admission was 13% with common abnormality as late Deceleration. Conclusion: CTG pattern of variable and late deceleration had correlated with the meconium stained liquor and nuchal cord only. There was no relation with neonatal outcome in terms of Apgar score and admission rate.

Cesarean Section in a Maternity Unit of a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study

Introduction:

Cesarean section is a common obstetric procedure which is done to reduce complications in high risk pregnancies. The aim of study was to find out the prevalence of cesarean section in a maternity unit of a tertiary care center.

Methods:

A descriptive cross-sectional study was conducted among 497 pregnant women presenting in a maternity unit of a tertiary center of Kathmandu, Nepal over a period of six months from March to August 2017 after taking ethical approval from Institutional Review Committee (Ref. 24). In this study, the prevalence of cesarean section, perinatal outcome, maternal and neonatal complications if any were observed. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data.

Results:

The prevalence of cesarean section was 171 (34.4%) at 95% Confidence interval (30.2-38.7). Most common indication for cesarean section was fetal distress 53 (31%). The maternal complications developed in 11 (6.4%) among those who delivered via cesarean delivery; Surgical Site Infection being the most common maternal complication. The neonatal intensive care unit admission rate among the newborns via cesarean section delivery was 48 (27.43%) and neonatal sepsis 14 (8%) was most common adverse neonatal outcome.

Conclusions:

The cesarean rate at the study center is higher than standard target rate of World Health Organization. Neonatal and maternal adverse outcome in current study were comparable with existing literatures.

Fractional deep neural network via constrained optimization

This paper introduces a novel algorithmic framework for a deep neural network (DNN), which in a mathematically rigorous manner, allows us to incorporate history (or memory) into the network—it ensures all layers are connected to one another. This DNN, called Fractional-DNN, can be viewed as a time-discretization of a fractional in time non-linear ordinary differential equation (ODE). The learning problem then is a minimization problem subject to that fractional ODE as constraints. We emphasize that an analogy between the existing DNN and ODEs, with standard time derivative, is well-known by now. The focus of our work is the Fractional-DNN. Using the Lagrangian approach, we provide a derivation of the backward propagation and the design equations. We test our network on several datasets for classification problems. Fractional-DNN offers various advantages over the existing DNN. The key benefits are a significant improvement to the vanishing gradient issue due to the memory effect, and better handling of nonsmooth data due to the network’s ability to approximate non-smooth functions.

Review of Perinatal Deaths in a Tertiary Care Hospital of Nepal

Aims: Perinatal mortality is a public health problem especially in developing countries like Nepal. This study is an attempt to assert the perinatal mortality status for the year 2016/2017 A.D. of Shree Birendra Hospital, a tertiary hospital. This study becomes imperative to comprehend the various shortcomings in the maternal and child health care, so as to remedy them effectively. Methods: This is a hospital record-based study conducted at Shree Birendra Hospital, Kathmandu, a tertiary care facility of the Nepal Army. The record of all perinatal death from 13th April 2016 to 12th April 2017 was reviewed. Results: Out of 1051 total births, there were 12 perinatal deaths with perinatal mortality rate of 11.42 per thousand births. Perinatal death was more prevalent in the age group 20-25 (58.33%), multiparous female (60%), period of gestation between 35-40 weeks (58.34%), male gender of baby (66.67%) but equal number of deaths was seen in both vaginal delivery and emergency LSCS. According to the Wigglesworth pathophysiological classification to classify perinatal deaths, conditions specific to neonate (33.3%) constituted as a significant cause perinatal death followed by stillbirths or neonatal deaths with congenital anomalies (25%) and conditions associated with prematurity (25%). Conclusions: Neonatal sepsis contributed to the major burden of perinatal mortality. Keeping detailed medical records, screening for Group B streptococcus in the third trimester, and using clinical autopsy can further strengthen obstetric and neonatal care. Keywords: early neonatal mortality rate, perinatal mortality, stillbirth

Prevalence and Outcome of Induction of Labor in a Tertiary Care Center of Kathmandu, Nepal

Aim: To study the prevalence of induction of labor and obstetric and neonatal outcome among delivery cases in the maternity unit of a tertiary care center. Methods: This is a prospective cross-sectional study conducted on pregnant ladies presenting to maternity unit of Shree Birendra Hospital, Chhauni over a period of six months from March to August 2017. All pregnant ladies in labor during the study period were enrolled. Induction of labor, mode of delivery, perinatal outcome (gestational age at delivery, birth weight), and maternal complications if any were recorded. Results: Among 497 deliveries in the study period, induction of labor was performed in 117 (23.5%) cases with post-date pregnancy being the most common indication. Induction was successful with vaginal deliveries in 82(70.1%) cases, while in the rest, IOL failed. Among the induced cases, 17 (14.5%) neonates had poor APGAR at 5 minutes and there was significant association of IOL with low APGAR. There was normal post-natal recovery in 108 (92.3%) induced cases while 9 (7.7%) cases developed some maternal complications. IOL has no significant association with maternal and neonatal complications or perineal injury (p>0.05). Conclusions: The prevalence of induction in this center is slightly higher than other centers. The IOL has significant association with low APGAR at 5 minutes but no significant association with the neonatal and maternal complications.

Transradial Access Results in Faster Skin Puncture to Reperfusion Time than Transfemoral Access in Posterior Circulation Mechanical Thrombectomy

BACKGROUND

Successful mechanical embolectomy for acute embolic arterial occlusion in the posterior cerebral circulation can potentially result in less neurologic disability and mortality. The transradial approach can potentially offer more direct navigation into the posterior circulation than the transfemoral approach and can result in faster recanalization time.

OBJECTIVE

To compare procedural metrics and the technical and clinical outcomes of transradial versus transfemoral access for mechanical embolectomy in the posterior cerebral circulation.

MATERIAL AND METHODS

Single-center retrospective review of a prospectively maintained neurointerventional database from a large volume neurointerventional service in a tertiary academic center. Patients presenting with acute disabling symptoms due to embolic occlusion of a large intracranial artery in the posterior that underwent to endovascular treatment in our institution from January 2017 to January 2019 were included in the present study.

RESULTS

Between January 2018 and January 2019 a total of 10 subjects underwent a mechanical embolectomy for acute embolic occlusion on the posterior circulation via transradial access; and between January 2017 and January 2018 a total of 10 subjects underwent a mechanical embolectomy for acute embolic occlusion on the posterior circulation via transfemoral access. Subjects in the transradial access group had a shorter skin puncture to recanalization time compared to the transfemoral group (29.2 ± 17.6 in the transradial group vs. 63.9 ± 56.7 in the transfemoral group respectively).

CONCLUSIONS

This is the first study comparing transradial versus transfemoral access for mechanical embolectomy in patients with acute embolic occlusion in the posterior cerebral circulation. Transradial access resulted in a safe, effective, and faster endovascular route for recanalization in the acute embolic occlusion of the posterior circulation.

Analysis of Cesarean Section Using Robson’s 10-Group Classification at a Tertiary Level Hospital in Nepal

Introduction: Obstetric Services commenced at the teaching institute where this study was conducted from Aug 2012. Hence, a review of the data of C-section in this hospital is needed for standardisation of the obstetric services in terms of the rate of C-section, its various clinical indications and maternal and fetal outcomes.Methods: This is a retrospective study carried out over a period of 5 years from Aug 13, 2012 to Aug 11, 2017. All hospital deliveries conducted during the study period were included in this study and the patients’ details obtained from hospital records. All data obtained was recorded in master charts and analysed using SPSS version 23. The caesarean rate, its indications were calculated and categorised into groups according to Robson’s 10-group classification. Results: A total number of 4892 deliveries were conducted over this 5-year study period. C-section was performed in 1104 patients, giving a C-section rate of 22.57%. The most common indications were previous C-section (25.4%), fetal distress (14.3%) and breech presentation (10.3%). Robson’s Group 1 was the highest contributors to the overall CS rate, contributing 28% of all C-sections, followed by Group 5 (26.8%) and Group 3 (15.5%).Conclusions: Nulliparous and multiparous women in term pregnancy in labor and women with previous C-section contribute to more than 70% of overall C-sections at our centre. Hence, close monitoring of these groups of patients, increasing the use of instrumental delivery and practice of vaginal birth after C-section can significantly reduce the C-section rate in our centre. 

High risk pregnancy and Fetal outcome at Shree Birendra Hospital

Introduction: High risk pregnancy is a major cause of morbidity and mortality in a developing country. These patients are recognized in the initial prenatal office visit as they have a poor obstetrical history or a well recognized medical complication however; pregnancy becomes high risk because they develop unexpected complications in the course of otherwise normal pregnancies. The objective of this study is to identify various type of high risk pregnancy and fetal outcome. Methods: This was a descriptive study conducted in Shree Birendra military hospital over a period of 9 months. Patients were recognized as high risk during antenatal visit and during admission. They were followed till delivery. The case records of all high risk pregnancy with their fetal outcome were analyzed. Statistical analysis was done using simple percentage. Results: Total deliveries during study period was 626. High risk pregnancy identified were 99 (15.81%). Previous lower segment cesarean section was the most common identified high risk pregnancy 34 (5.43%) followed by young primigravida 3.19%, breech 2.23%. There were total 13 low birth weight baby (13.13%) and 2 stillbirth (2%) as fetal outcome. Conclusion: Identification of high risk pregnancy during antenatal period will reduce adverse perinatal outcome.

Incidence of Hypertension in the Nepalese Army selected for United Nation's Mission

Introduction: Hypertension is an important public health challenge in the developing and the developed world alike. However, hospital-based studies on cardiovascular diseases including hypertension in a developing country like Nepal have been limited. The objective of the present study was to determine the incidence of hypertension in the troops selected for mission.Method: We did medical check-up of 850 soldiers selected for UNIFIL mission from January 2014 to March 2014 at Shree Birendra Hospital Chhauni, Kathmandu. Age ranged from 29 years to 55 years was included in the group. Various parameters like history of diabetes mellitus, hypertension, coronary artery disease, smoking, alcohol, family history, measurement of blood pressure, body mass index, lipid profile and number of people who has to take antihypertensive medicines were studied.Results: Out of 850 military personnel 48 found to have high blood pressure. Maximum candidates belonged to young age group 29-35years of age. 22 were overweight and 6 were obese and having higher blood pressure levels. 66% were habituated to alcohol intake minimum 60 ml up to 160 ml. Most of them were occasional drinker. 31 candidates constituting 64.58% had to be put on antihypertensive that were newly diagnosed. 3 persons had past history of hypertension and were already on antihypertensive.Conclusions:  The study highlights the prevalence of various risk factors for coronary artery disease in the army.Since majority of risk factors are modifiable, timely intervention can help in reducing morbidity and mortality.

Study of abnormal papsmear result in army families

<p>To study the incidence of abnormal&nbsp; papsmear in Shree Birendra Hospital in the year 2068 among army families. Method: Among the army families all sexually exposed ladies up to age group 60 yrs. are subjected to papsmear. The groups who had positive result are subjected for colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer, received appropriate treatment. Result: Among 7000 gynaecological patients examined in the gynaecology outpatient department 1100 pap smears were done. Out of this, total normal smear were 647 rests were abnormal. Conclusion: In low resource settings a single papsmear testing was associated with significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancers. Therefore, in low resource settings where colposcopy, biopsy, or follow-up with pap smears cannot be done effectively, cryotherapy, as part of a single visit approach is &nbsp;still needed.</p>

incidence of hypertension in the mission

<p>Hypertension is an important public health challenge in the developing and the developed world alike. However, hospital-based studies on cardiovascular diseases including hypertension in a developing country like Nepal have been limited.</p> <p>Objective: The objective of the present study was to determine the incidence of hypertension in the troops selected for mission. This is a small scale prospective study.</p> <p>Method:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; We did medical check-up of 850 soldiers selected for UNIFIL mission from January 2014 to March 2014 at Shree Birendra Hospital Chhauni, Kathmandu. Age ranged from 29yrs to 55yrs was included in the group. Various parameters which were studied included: history of diabetes mellitus, hypertension, coronary artery disease, smoking,alcohol, family history, measurement of blood pressure, body mass index, lipid profile and number of people who has to take antihypertensive medicines.</p> <p>Results: Out of 850 military personnel 48 found to have high blood pressure.Maximum candidates belonged to young age group 29-35years of age. 22 were overweight and 6 were obese and having higher blood pressure levels. 66% were habituated to alcohol intake minimum 60 ml up to 160 ml. Most of them were occasional drinker. 31 candidates constituting 64.58% had to be put on antihypertensive that were newly diagnosed. 3 persons had past history of hypertension and were already on antihypertensive.</p> <p>Conclusions:&nbsp; The study highlights the prevalence of various risk factors for coronary artery disease in the army.Since majority of risk factors are modifiable, timely intervention can help in reducing morbidity and mortality.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</p>

Basic sciences: an alternative career?

Career selection is a crucial and a complex process which is also true for the medical profession. In the context of our country, due to the limited opportunity and proper guidance, migration of medical graduates to foreign countries is increasing. Though, clinical subjects have a huge attraction, basic science field has failed to impress our medical graduates. In current scenario, basic science field seems to be a dumping site for the incompetent as the candidates who have failed trying their luck elsewhere stumble upon basic science careers though it is not true for all. Moreover, a very few medical graduates are interested in developing their career as a basic scientist. Therefore, to motivate today's young medical graduates, there is a need of a good mentor along with a proper career guidance which can help them to understand the basic science field as an alternative career.

Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone

Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment.We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no “M spike” but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.   Keywords: acute kidney injury; bortezomib; cast nephropathy; multiple myeloma.

Study of Auditory function in Rheumatoid Arthritis

Rheumatoid Arthritis may affect the auditory function and is a subject of debate. The exact etiopathogenesis is not known. However there is evidence of rt of synovial joints of ossicles. Rheumatoid Arthritis may involve the Aoditory system by producing conductive hearing loss, abnormal otoadmittance and sensorineural hearing loss. Patients with pre-existing ear disease were not included in the study. In the present study, effcet of Rheumatoid Arthritis on auditory function is observed. The Study was carried out on 25 patients of classical or definite Rheumatoid Arthritis and 16 controls at M.Y. Hospital, Indore.

Management of tracheocutaneous fistula

We describe a simple technique that utilises local skin flaps of closure of a large tracheocutaneous-fistula with a adequate support to the tracheal wall by double breasting of local flaps, thus avoiding the post-operative respiratory problems that can occur due to a single flap projecting into the tracheal lumen during inspiration.This technique avoids the complications associated with primary closure of fistulae & also the morbidity of waiting for secondary closure to occur. It also precludes the need for a more extensive operation in the form of muscle flap rotation. The fistulous tract does not need to be excised but forms a component of the repair.

Lambda light chain myeloma with oliguric cast nephropathy and remission with bortezomib, doxorubicin and dexamethasone

Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment. We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no "M spike" but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.

Microcatheter to recanalization (procedure time) predicts outcomes in endovascular treatment in patients with acute ischemic stroke: when do we stop?

BACKGROUND AND PURPOSE

Endovascular treatment for acute ischemic stroke consists of various mechanical and pharmacologic modalities used for recanalization of arterial occlusions. We performed this study to determine the relationship among procedure time, recanalization, and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment.

MATERIALS AND METHODS

We analyzed data from consecutive patients with acute ischemic stroke who underwent endovascular treatment during a 6-year period. Demographic characteristics, NIHSS score before and 24 hours after the procedure, and discharge mRS score were ascertained. Procedure time was defined by the time interval between microcatheter placement and recanalization or completion of the procedure. We estimated the procedure time after which favorable clinical outcome was unlikely, even after adjustment for age, time from symptom onset, and admission NIHSS scores.

RESULTS

We analyzed 209 patients undergoing endovascular treatment (mean age, 65 ± 16 years; 109 [52%] men; mean admission/preprocedural NIHSS score, 15.3 ± 6.8). Complete or partial recanalization was observed in 176 (84.2%) patients, while unfavorable outcome (mRS 3-6) was observed in 138 (66%) patients at discharge. In univariate analysis, patients with procedure time ≤30 minutes had lower rates of unfavorable outcome at discharge compared with patients with procedure time ≥30 minutes (52.3% versus 72.2%, P = .0049). In our analysis, the rates of favorable outcomes in endovascularly treated patients after 60 minutes were lower than rates observed with placebo treatment in the Prourokinase for Acute Ischemic Stroke Trial. In logistic regression analysis, unfavorable outcome was positively associated with age (P = .0012), admission NIHSS strata (P = .0017), and longer procedure times (P = .0379).

CONCLUSIONS

Procedure time in patients with acute ischemic stroke appears to be a critical determinant of outcomes following endovascular treatment. This highlights the need for procedure time guidelines for patients being considered for endovascular treatment in acute ischemic stroke.

Clinicopathological Analysis of Ovarian Tumours at Birendra Military Hospital

Introduction: Ovarian cancer is the second most common genital tract malignancy accounting for 25% gynaecological malignancy. This study was conducted to determine the incidence, epidemiological factors and clinical presentation of different types of ovarian tumours their correlation with histopathology. Methods: This is a descriptive study conducted in Birendra Military Hospital over a period of 2 years. The case records of all the patients with ovarian tumur was analyzed. Results: Of the total of 135 adnexal masses cases 100 (74.07%) were found to be histologically proven ovarian tumour out of which 35 were non neoplastic conditions. Benign tumours comprised of 68 (68%) and 32 (32%) were malignant and borderline.Mature cystic teratoma 28 (75%) was the commonest benign tumour, whereas serous cystadenocarcinoma 13 (64.3%) were commonest malignancy. Age varying from 2.5 yrs. To 70 yrs. Smallest tumour size was 2.5 cm. largest was 40 cm. Commonest symptom was abdominal discomfort and most common sign was abdominal lump. Malignancy usually presented with ascites especially epithelial ovarian tumours. Germ cell tumour was observed in younger age group in earlier stage. Conclusion: The commonest ovarian tumor was epithelial followed by germcell. Mature cystic teratoma was the most common benign tumour and malignant was serous cyst adenocarcinoma. Epithelial ovarian tumour prevalent in perimenopausal and postmenopausal age group whereas germ cell in earlier age. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6446 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 26-31

Prevalence of HIV/AIDS in Nepal Army and its Dependants

Introduction: The Asia Pacific Region is currently at the “tip of iceberg” phase of the HIV/AIDS epidemic after African countries causing irreparable economic damage and undermining national and regional security if left unattended. HIV/AIDS remains a serious national concern and potential for epidemic relapse is high1. Continued vigilance is important. Study of the Prevalence of HIV/AIDS in Nepal Army (NA) and its dependants is based on the data collected from various sources to highlight the importance of ongoing measures plus the need of effective programs against HIV/AIDS control. Methods: This is a descriptive study and data are derived from February 1996 to March 2011 from the different sources. National Guideline for testing of HIV in Nepal, developed in 2003 was used for the diagnosis of the cases by blood tests in Birendra Hospital, Chhauni. Results: Total of 116 cases was diagnosed HIV positive. Maximum number of HIV positive cases was diagnosed in the year 2010 as compared to other years since 1996 and for the year 2011 till the month of March. The positive cases diagnosed from army personnel in UN Mission and blood donation programs accounted for 0.02% and 0.09% respectively. And from the surgical patients in the army hospital, 0.18% cases were diagnosed positive. From the year 2006 to 2010, 0.38% cases were diagnosed as positive among the voluntary counselling and testing (VCT) volunteers. Conclusion: HIV is a threat to the army, behaviour change and prevention is the key and it needs to be adapted to the best. Intensive training, massive awareness programs and behavioural issues start at the recruit level and need to be reinforced prior and during deployment with regular monitoring of the soldiers activities. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6445 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 20-25

Triiodothyronin, thyroxine and thyrotropin in vitiligo

BACKGROUND

Vitiligo is a common pigmentary disorder of the skin, affecting individuals globally. Not only is this ailment psychologically incapacitating, it also has a high incidence of autoimmunity, signifying that its manifestations may be the portrayal of dysfunction of immune system.

OBJECTIVE

The aim of this study is to find out the situations of abnormal thyroid function test (TFT) in vitiligo patients.

METHODS

A prospective cross sectional study was conducted at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to January 2011 with the objective to assess the thyroid function tests in vitiligo patients.

RESULTS

Total 66 vitiligo patients with male 30 (45%) and female 36 (55%). Total 26 (39.39%) vitiligo patients have been found to have abnormal thyroid function test. Among them 10 had abnormal T3, seven had abnormal T4 and 12 had abnormal TSH level. Thyroid function test were normal in other vitiligo patients. Total seven vitiligo had high level of T3 than normal value, four male and three female. Two had higher level of T4 above 2.0 ng/dl and all were male, while five had abnormally low level of T4 with three male and two female. There were seven vitiligo patient with increased T3 level and three with decreased T3 level, among them six were males and four were females, the age group was ranged from seven to 68 years old. The T4 level were found abnormal in seven vitiligo patients among which five were males and two were females with the age group ranging from 7 to 51 years.

CONCLUSIONS

There has been significant association of thyroid disorder in the patient with vitiligo. Therefore, patient with vitiligo need to undergo thyroid function test to rule out the thyroid disorder and prevent from long-term complications.

Requirements for emergent neurosurgical procedures among patients undergoing neuroendovascular procedures in contemporary practice

BACKGROUND AND PURPOSE

Provisions for an emergent neurosurgical procedure have been a mandatory component of centers that perform neuroendovascular procedures. We sought to determine the need for emergent neurosurgical procedures following neuroendovascular interventions in 2 comprehensive stroke centers in settings with such provisions.

MATERIALS AND METHODS

Analysis of retrospectively collected data from procedure logs and patient charts was performed to identify patients who required immediate (before the termination of the intervention) or adjunctive (within 24 hours of the intervention) neurosurgical procedures related to a neuroendovascular intervention complication. The types of neurosurgical procedures and in-hospital outcomes of identified patients are reported as an aggregate and per endovascular procedure-type analyses.

RESULTS

We reviewed a total of 933 neuroendovascular procedures performed during 3.5 years (2006-2010). A total of 759 intracranial procedures were performed. There was a need for emergent neurosurgical procedures in 8 patients (0.85% cumulative incidence and 1.05% for major intracranial procedures) (mean age, 46 years; 7 were women); the procedures were categorized as 3 immediate and 5 adjunctive procedures. There were 5 in-hospital deaths (62.5%) among these 8 patients. Neurosurgical procedures performed were external ventricular drainage placement in 6 (6 of 8, 75%) patients, decompressive craniectomy in 1 (12.5%) patient, and both surgical procedures in 1 (12.5%) patient.

CONCLUSIONS

The need for emergent neurosurgical procedures is very low among patients undergoing intracranial neuroendovascular procedures. Survival in such patients despite emergent neurosurgical procedures is quite low.

Knowledge, behavior and attitude towards sexually transmitted infections and acquired immunodeficiency syndrome of adolescent students

BACKGROUND

Adolescence is a period of great physical, mental and emotional turmoil within teenagers. The objective of the study was to assess the knowledge of, attitude to and behaviour towards STI and AIDS among adolescence.

METHODS

Four randomly selected higher secondary school from students of class XI and XII were included after taking their verbal consent. A pre-designed and pre-tested questionnaire was given to all the participants of the school. In order to get correct answers, specific questions were explained to the students with the help of their class teachers.

RESULTS

The results were encouraging with the majority (94.16%) have heard about STIs and HIV/AIDS. Teachers (100%), Newspaper/magazine (90%) and Television (78.33%) were the main informational source about disease. Respondents correctly identified that unsafe sexual contact (86.66%) as major mode of transmission of AIDS and more than 90% of students regarded the use of condoms as the true preventive method for the disease. Among those respondents 6% were sexually active and their partners were either sex worker (71%) or friends (29%).

CONCLUSIONS

The student's attitude towards disease was positive and most of the adolescent wished inclusion of sex education in their text book from secondary level school's curriculum.

Allergic fungal rhinosinusitis in chronic rhinosinusitis

BACKGROUND

Rhinosinusitis is the inflammation of nasal and paranasal sinus mucosa and is associated with mucosal alteration ranging from inflammatory thickening or gross nasal polyp formation.The main objective of this study is to determine the prevalence of allergic fungal rhino sinusitis among the patients having chronic rhino sinusitis with or without polyps who under goes functional endoscopic sinus surgery.

METHODS

The patient with chronic rhinosinusitis with or without polyp who FESS were studied. Surgical specimens were sent for mycology and histopathological analysis for identification of fungus.

RESULTS

Headache 41(82%) and nasal block 45(90%) were the commonest clinical presentation. Out of 50 patients, fungal elements were detected by KOH in 8(16%) of cases and histopathological examination in 11(22%) of cases.

CONCLUSIONS

Allergic Fungal Rhinosinusitisis a common disorder in patients with chronic rhinosinusitis, it need different specific tests for the diagnosis, a more specific diagnostic tests are fungus culture, and IgE to fungal antigen and skin test are needed for definite diagnosis.

Histomorphological spetrum of breast lesions

BACKGROUND

Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon.

METHODS

This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010.

RESULTS

114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male.

CONCLUSIONS

Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal.

A simple new technique of performing myomectomy for a predominantly subserosal myoma quickly within few minutes

Removing a degenerated myoma located around the uterine cornu by an innovative technique shelling the myoma a little away from the base by choice of a low placed incision, advantageous in terms of no requirement of blood transfusion because of the reduction in the surgical time is described in a 24 years old lady demanding a fertility conserving surgery.

Human Immune Deficiency Virus-1: Diagnosis and Treatment in Adults and Adolescents

Human Immune Deficiency Virus-1: Diagnosis and Treatment in Adults and Adolescents

Chorioangioma of Placenta

We report a case of Chrioangima of placenta resulting to hydropsfetalis. A 24 yrs old primigravida with polyhydramnios and large placental chorioangioma at 24 wks of gestation expelled a nonimmune hydropic male baby weighing 900gms. The baby expired after 5 minutes of expulsion. Keywords: Placental chorioangioma; Hydropsfetalis; Polyhydraamnios DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5026 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 44-46

Eisenmenger's Syndrome in Pregnancy

DOI: http://dx.doi.org/10.3126/njog.v5i2.5083NJOG 2010 Nov-Dec; 5(2): 55-56